Many Americans still get their HIV diagnosis years after infection

Liz Highleyman

Published: 30 November 2017

Many people with HIV in the United States
are still being diagnosed with HIV late, and therefore not getting the full therapeutic
and prevention benefits of starting antiretroviral therapy (ART) early,
according to the latest Vital Signs report from the US Centers
for Disease Control and Prevention (CDC), released in advance of World AIDS
Day.

People at risk for HIV in the US
are getting tested more often than they did in the past and are living with HIV
for a shorter period of time before diagnosis, CDC officials said during
the media briefing on 28 November. The median time between infection and diagnosis was
three years in 2015, a seven-month decline since 2011.

"If you are at risk for HIV, don’t guess—get a test," said
Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral
Hepatitis, STD, and TB Prevention. "The benefits are clear. Prompt
diagnosis is prevention. It is the first step to protecting people living with
HIV and their partners."

Effective
ART prevents T-cell loss and the decline of immune function, and studies definitively
show that people who are on treatment that suppresses their viral load to an
undetectable level do not transmit HIV. US and World Health Organization
guidelines now recommend universal treatment for everyone diagnosed with HIV.

Getting
tested is the first step to starting treatment. The CDC
recommends that everyone age 13 to 64 should get a routine HIV test at least
once, people at high risk for infection should get tested annually and those
using pre-exposure prophylaxis (PrEP) should get tested quarterly.

But HIV testing and diagnosis often does not happen in a timely manner.
The CDC estimates that 15% of people living with HIV in the US do not know
their status, and more than 40% of new infections are attributable to people
who are unaware that they have the virus.

As described in the 28 November edition of Morbidity and Mortality Weekly Report, the new Vital Signs report says that half of the nearly 40,000 Americans diagnosed
with HIV in 2015 had been living with the virus for at least three years, a
quarter had been infected for seven years or more and 20% already had AIDS at
the time of diagnosis.

As is
typical of the HIV epidemic, the amount of time spent undiagnosed varied across
demographic groups. Heterosexual men had undiagnosed HIV longer than women who
inject drugs or gay and bisexual men (a median of about five years, two years
and three years, respectively). Asian Americans went undiagnosed for about four
years, African
Americans and Latinos for about three years and whites for about two years,
according to the report.

Among the
groups most likely to acquire HIV, 29% of gay and bi
men, 42% of people who inject drugs and 59% of at-risk heterosexuals in a
multistate study said that they had not been tested in the past year. Of these,
70% reported that they had seen a healthcare provider during that time,
"signaling missed opportunities" for testing," Mermin said.

"Now
more than ever, we have the prevention and treatment tools to stop HIV,"
Mermin and Eugene McCray, director of the CDC's Division of HIV/AIDS
Prevention, wrote in a letter to colleagues.

"For
people living with HIV, getting a test is the first step to starting
antiretroviral therapy, which can preserve their health and prevent HIV
transmission to partners," they continued. "We are closer than ever
to achieving a future free of HIV in the United States, and we have the
prevention and treatment options to get there. But more HIV testing is needed
to make sure those powerful tools are available to people who can benefit from
them."

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap

close

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends
checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member
of your healthcare team for advice tailored to your situation.